Basic Information
| Provider Information | |||||||||
| NPI: | 1841495710 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIN | ||||||||
| FirstName: | WILLIAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 370 | ||||||||
| Address2: | |||||||||
| City: | FORTSON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 318080370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | 7064943008 | ||||||||
| Practice Location | |||||||||
| Address1: | 631 PROFESSIONAL DR STE 170 | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300463392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6783122663 | ||||||||
| FaxNumber: | 7709628587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2007 | ||||||||
| LastUpdateDate: | 12/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0801X | 30917 | AL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma | 207XX0801X | 70971 | GA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma |
ID Information
| ID | Type | State | Issuer | Description | 051120546 | 01 | AL | BCBS | OTHER | 051120544 | 01 | AL | BCBS | OTHER | 131854 | 05 | AL | MEDICAID | 131852 | 05 | AL | MEDICAID | 131856 | 05 | AL | MEDICAID | 051120547 | 01 | AL | BCBS | OTHER | 051120543 | 01 | AL | BCBS | OTHER | Z21050 | 01 | AL | VIVA | OTHER | 07570265 | 05 | MS | MEDICAID | 131850 | 05 | AL | MEDICAID |